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Chapter III: Characteristics of Early Head Start Programs

Documenting the key characteristics of Early Head Start programs, their communities, and enrolled families is important for understanding how programs operate. This chapter describes the context of Early Head Start programs and the families they serve. We begin by describing the settings in which programs operate—including community factors such as urbanicity, cultural diversity, agency auspices, affiliation with a Head Start program, and funding sources agencies use to provide Early Head Start services. We then describe program enrollment, recruitment practices, and basic demographic characteristics of Early Head Start families, and follow with discussion of specific target populations that programs serve, including the extent to which programs serve high-risk families and children with disabilities. In this chapter, we use findings from survey data in two ways. First, we describe program-level data from the survey of all programs (for example, the percentage of programs serving families with particular attributes). Second, we describe some data at the enrolled population level (the percentage of all Early Head Start families with particular attributes). We use pull-out text boxes to describe program and family characteristics based on site visit data from 17 selected programs.

THE PROGRAM SETTING

Early Head Start programs individualize their services precisely because they serve a broad range of communities, as families in different communities have different needs.

Population Density. Early Head Start operates in a broad range of settings, from rural to urban and suburban. Some agencies operate programs in more than one type of setting, such as one in an urban area, and other satellite or delegate program in an outlying rural area. Early Head Start programs are roughly evenly divided between primarily urban (45 percent) and primarily rural (42 percent) service areas (Table III.1). Ten percent operate in mainly suburban areas. Only a handful (2 percent) operate in service areas with a fairly equal mix of two or more categories.

Table III.1 Key Characteristics of Early Head Start Programs

Characteristic		Percentage of Programs
Program Service Area	Mainly urban	45.2
	Mainly rural	42.0
	Mainly suburban	9.5
	Mixed	2.3
	Other	0.9
Number of Program Centers a	Single	35.8
	Multiple	64.2
Community Diversity	High	18.9
	Moderate	41.2
	Low	39.9
Diversity Past Five Years	Increased	42.3
	Stayed the same	56.3
	Decreased	1.4
Agency Nonprofit Status	Private nonprofit	68.7
	Public agency	28.0
	Private for-profit	1.8
	Other	1.5
Program Auspices	Community agency	69.7
	School	9.9
	Government agency	5.8
	Tribal government	4.4
	University	3.5
	Hospital or health care provider	3.4
	Other	3.4
	Program Operates Own Preschool Head Start	81.6
Sample Size (Programs)		461-657 b

Source: Survey of Early Head Start Programs. a Does not include family child care or home-based services. b Most questions have sample sizes over 640. Number of Program Centers has a sample size of 461 because it includes only programs that operate an Early Head Start Center.

Number of Centers or Sites. About two-thirds of programs operate multiple Early Head Start centers or sites. Programs usually define their service areas by county lines (67 percent), although some use school districts, zip codes, or neighborhoods (not shown). Some programs (24 percent) report using more than one of these definitions to determine the boundaries of their service area.

Community Diversity. Sixty percent of programs are in areas that programs characterize as being of “moderate” or “high” cultural diversity. We also asked programs to indicate change over the past five years; many programs (42 percent) are also in areas of increasing cultural diversity. Here, we discuss community diversity as distinct from program diversity—because the families served by Early Head Start may not represent all races and cultures in the service area. Still, community diversity is an important consideration for program individualization, because programs in diverse areas may need to find ways to make services attractive to multiple cultural groups and to serve families that speak languages other than English. Rapid changes in community diversity can place stress on program management and hiring as programs adjust to different family needs and cultures.

Program Auspices. Agency auspices play a role in programs’ approaches to management and service delivery, because agencies differ in the resources they have to offer Early Head Start programs as well as in their requirements for program management. Most Early Head Start programs are operated by nonprofit community agencies. The majority (69 percent) of programs have private nonprofit status, and a substantial minority (28 percent) are public agencies. Just 3 percent are operated by for-profit companies. Overall, most Early Head Start programs are operated by community agencies, such as community action agencies, community-based organizations, and faith-based organizations (70 percent). Government agencies or tribal governments account for 10 percent of programs, schools account for 10 percent, and the remaining 10 percent are run by universities, health providers, and other types of agencies.

Integration with Head Start. More than 80 percent of Early Head Start programs are run by grantees that also operate a Head Start program. Information collected through site visits suggests that program integration is an ongoing process and that even when Early Head Start and Head Start operate under the same organization, the two programs may function independently. (Box III.1 describes strategies for integrating Early Head Start and Head Start programs and the challenges in doing so, based on site visit data.)

PROGRAM FUNDING

The Office of Head Start provides grants to grantee agencies that can pass the funding through to delegates, provide Early Head Start services directly, or do both. In addition, federal performance standards require that programs raise 20 percent of total program costs through non-federal funds. Matching contributions can be made either through cash donations or through in-kind products, resources, or services. Both monetary and in-kind contributions can be produced by the grantee or delegate agency itself or through outside sources. Programs cannot require that families pay any fees for participating in Early Head Start.

BOX III.1 INTEGRATING EARLY HEAD START AND HEAD START PROGRAMS The Office of Head Start has encouraged collaboration between Early Head Start and Head Start programs. Among the potential benefits of integrated programs are smoother transitions for families, stronger relationships between families and program staff over time, enhanced access to community partners and other resources for families, and opportunities for staff members to broaden their expertise in early childhood development (DHHS 2005). We selected programs that vary on their affiliation with a Head Start program for site visits. Directors at more than half the programs visited as part of this study consider their programs to provide seamless services for children aged birth to 5. During site visits, staff describe promising strategies for creating integrated programs as well as challenges they face in doing so. Staff members described integration strategies focusing on program organization and service delivery to move toward better integration of Early Head Start and Head Start. Specific steps programs have taken include the following: Reorganizing management and staff. Some programs have changed their organizational structure so that one director is responsible for both Head Start and Early Head Start. This director typically supervises an administrator with overall responsibility for Early Head Start and/or specialists who serve families and staff in both programs. Creating shared staff training plans and using similar curricula and forms. Several programs report integration strategies such as creating staff training plans that cover both Head Start and Early Head Start, choosing a curriculum that can be shared across the programs with appropriate adaptation, and having common forms and management information systems for both programs. Combining Policy Councils. Programs working to integrate Early Head Start and Head Start programs often have a single Policy Council for Head Start and Early Head Start. Typically, fewer Early Head Start parents serve on the council, but they sometimes hold leadership positions. Administering a single federal grant for Early Head Start and Head Start. Some programs have received approval to submit a single federal grant application for both Early Head Start and Head Start funding. Managers say that this helps create a stronger administrative link between the two programs, although budgets must still be tracked separately. Program staff members also highlighted integration challenges related to differences in program size, comfort with and expertise in serving children of different ages, transitions between Early Head Start and Head Start, and program finances. Differences in program size. Early Head Start programs typically have a much smaller funded enrollment size than their Head Start counterparts in the same agency. Imbalance in enrollment levels may have implications for sharing specialists across programs, as the larger program is likely to place more demands on staff time. Differences in program size may also make it more difficult for Early Head Start parents to have a strong voice in making decisions that affect both programs if parent representation on the council is proportional. Need for expertise in serving younger or older children. Managers at some programs receiving site visits noted that moving toward integration meant addressing perceptions among Early Head Start or Head Start staff members that they did not have the skills or capacity necessary to work with children in both age groups. Program leaders must be aware of the important differences in the needs of children in each age group and in the training required for staff working with each group. Difficulty transitioning families between Early Head Start and Head Start. Staff at several programs note that problems can arise when families’ eligibility must be recertified before they enter Head Start, particularly if a family’s income has increased since enrolling in Early Head Start. Another problem is lack of available Head Start slots for children whose birthdays occur mid-year. Some programs continue to serve these children in Early Head Start for the rest of the year. Segregation of program budgets. A logistical challenge mentioned by managers is the requirement that Early Head Start and Head Start budgets and expenditures be tracked separately, even when the programs share a single grant number, staff, and facilities.

Nearly two-thirds of programs use additional outside funding sources to provide Early Head Start services (Table III.2).1 Programs use additional funds for an array of purposes, from improving Early Head Start services to offering other services, such as dental screenings, father involvement support, and language and cultural training. However, additional funding sources introduce management challenges for programs, such as contending with reporting requirements for multiple funders and working to sustain funding to continue new services. Box III.2 describes the challenges some programs we visited face in managing multiple grants.

BOX III.2 MANAGING MULTIPLE GRANTS IN EARLY HEAD START During site visits, we learned about the ways programs pursue and use outside funding sources. Administering more than one grant can be a challenge, because it is necessary to report to more than one funder and difficult to sustain funding for limited-term grant activities. Some of the programs we visited that have additional funding sources mentioned burdensome additional reporting requirements, more complex budgeting issues, and other extra requirements. In addition, new grants often involve initiating new services in the Early Head Start program and hiring new staff, but grant funding is time limited, and continuation funds can be difficult to obtain. Several programs report that sustaining funding over time is a challenge, and another program notes that shifting state budgets make it difficult to predict how child care subsidies will fit into future budgets. Furthermore, programs may not always be able to use outside funding to meet their most pressing needs, because grant funds usually can only be used for certain purposes. For example, one director notes that in the year preceding the site visit, the program had more than enough money for technology services but did not have funds to paint the facility. Despite these challenges, however, program staff feel that the additional service opportunities afforded by extra funding are important enough to merit the added effort.

Table III.2. Early Head Start Program Funding

Characteristic		Percentage of Programs
Program Funding Sources	Any outside funding sources	62.5
Funding Sources	State child care subsidies or block grant	34.2
	State government grant	17.7
	Private foundation grants	14.9
	Fundraising activities	13.1
	Fee-for-service reimbursements	8.5
	County or municipal government grant	8.2
	Part C funds	6.3
	Contracts	5.6
	Grants provided by businesses	5.3
	Other source	6.5
Use of Additional Funding Sources	Child care	47.7
	Improvements to existing Early Head Start services	41.2
	Parent activities	26.0
	Additional Early Head Start staff	24.1
	Staff training or technical assistance	22.9
	Additional Early Head Start enrollment slots	15.2
	Services for Part C children or families	14.9
	New Early Head Start services	8.9
	Other use	11.6
Number of Additional Funding Sources	Programs with no additional sources	37.5
	Programs with 1 additional source	31.2
	Programs with 2 or 3 additional sources	25.7
	Programs with 4 or more additional sources	5.7
Sample Size (Programs)		415-654 a

Source: Survey of Early Head Start Programs. a Most questions have sample sizes over 640. One question has a low sample size because it applied only to certain programs: Use of Additional Funding Sources applies only to the 415 programs that report having any additional funding.

The most common sources of additional funding for Early Head Start programs are state subsidies or local grants. One-third of programs use state child care subsidies, and more than a fourth use state, county, and municipal grants (26 percent). Private funding is another main source of additional funding for one-third of programs and includes foundation grants, individual donations, and grants from businesses. Other federal and outside funding sources, used by 20 percent of programs, include fee-for-service funds, contracts, and Part C funds.

EARLY HEAD START ENROLLMENT

Program enrollment is carefully regulated by the Head Start Program Performance Standards and is part of the core area of Eligibility, Recruitment, Selection, Enrollment, and Attendance (ERSEA). Families with children under age 3, and pregnant women, both with incomes below the poverty line (or whose families are eligible or potentially eligible for public assistance) can be enrolled. Programs may impose additional eligibility requirements. Performance standards also lay out requirements for maintaining waiting lists, prioritizing children for enrollment according to need, and ensuring that enrollment slots are filled. The performance standards also specify that 10 percent of enrollment slots should go to children with disabilities and that 10 percent of enrollment slots may go to families with incomes over the federal poverty threshold. (Box III.3 describes programs’ enrollment criteria, using site visit interview data.)

Within the enrollment criteria, local programs have some flexibility in how they prioritize families for enrollment. Programs typically integrate the requirements laid out in ERSEA, any additional local eligibility requirements, and local needs they have identified to design programs that are individualized for their communities into a rating system that give priority to the neediest families.

Program Size. Most Early Head Start programs serve fewer than 100 children, and overall mean actual enrollment for Early Head Start is 84 children and pregnant women.2 However, the few programs with more than 200 enrollees inflate the average (Figure III.1). Just under one-third of programs serve 50 or fewer pregnant women and children; 41 percent of programs serve between 50 and 100. Very large programs, serving 150 or more children and pregnant women, make up 11 percent of programs, and the remaining 16 percent serve between 101 and 149 children and pregnant women. Altogether, program size varies widely, with enrollment ranging from fewer than 10 to nearly 600 children and pregnant women.

Age of Children. The population of children enrolled in Early Head Start consists mainly of 1- and 2-year-olds. Based on survey data, among all children served by Early Head Start, 31 percent are age 1 and 37 percent are age 2. Babies under age 1 make up about 22 percent of children served, and most of the remaining children are 3-year-olds (Table III.3). We asked separately about the proportion of children entering the program at various ages and then about age of exit—so the two are not directly comparable but we can get a sense of the flow of children in and out of the program more generally. About 13 percent of children enter the program in the prenatal period, but most enter Early Head Start between birth and age 2 (62 percent). Fewer (19 percent) enter at between 2 and 3 years of age. Conversely, nearly half of enrolled children exit Early Head Start at some point after turning 3 (46 percent), 23 percent exit between ages 2 and 3, and 16 percent exit before age 2. (Survey items are not specific enough to calculate exact age of exit.) Very few pregnant women exit the program before the birth of their child (2 percent).

BOX III.3 ENROLLMENT CRITERIA IN EARLY HEAD START PROGRAMS Early Head Start is a voluntary program that is not an entitlement, so programs select enrollees among families that are interested in participating. Federal requirements restrict the service population to families with pregnant women and children up to age 3. Federal poverty guidelines determine families’ income eligibility for Early Head Start, although programs may enroll families above the poverty line up to 10 percent of total enrollment. Programs are also required to make at least 10 percent of slots available to children with special needs and make efforts to meet that percentage. Grantees or programs may impose more stringent or additional enrollment criteria at their own discretion. Most programs identify more eligible families than the number of slots they have available and therefore maintain a waiting list for enrollment. The federal performance standards require that programs establish waiting lists that rank children according to program criteria for prioritizing families based on community needs. The following data from our site visits describe the programs’ experiences selecting and enrolling families. Among programs participating in the site visits, about half use additional eligibility criteria beyond federal requirements. All but one visited program had a waiting list at the time of the interviews. Additional eligibility requirements typically pertained to family income level or employment status. Several programs impose a full-time work or school requirement on parents seeking center-based care or any Early Head Start services. These and the more stringent income criteria were usually due to requirements for receiving state child care subsidies or other supplemental funding. In addition, one program does not accept children over age 2 at the time of enrollment, because children age out of Early Head Start at age 3, and the staff members feel that families would not benefit from less than a year of services. One program requires that families document that they live in shelters or public housing to be eligible for services. All visited programs keep a list of families waiting for services, although one program had no families on the list at the time of the interview and another had a very small list. A couple of programs have very large waiting lists, and one has twice the number of families on the list as slots available. On average, however, the number of families on waiting lists is about half the number of total enrollment slots. Almost all Early Head Start programs that participated in site visits use a ranking system to select families for enrollment according to the highest level of need. Early Head Start programs usually maintain a waiting list, but when a slot becomes available, most do not enroll families solely according to length of time on the list. Instead, staff prioritize families for enrollment according to need, so the families with greatest need by local criteria on the waiting list are served first regardless of how long they have been waiting. Programs typically develop a scoring system for applicants, awarding points for family risk factors identified as priorities for the service area. The enrollment prioritization systems that programs use are individualized to the needs of the community. For example, one program uses the results of the community assessment to identify major community needs and worked with its policy council to develop a scoring system based on those needs. Teen parenthood, children with special needs, and particularly low family income or poverty are the priority risk factors cited most frequently by programs we visited. Some programs give families extra enrollment points for single parenthood, current pregnancy, mental health concerns, substance abuse, foster or kinship care, homelessness, not speaking English and other risk factors. Several programs award points for families with a previous history in Early Head Start or Head Start, particularly if the family has another child currently enrolled in Early Head Start. Although these point systems prioritize family needs and risk factors over the family’s length of time on the waiting list, some programs do award additional points to families for lengthy periods of time spent waiting for services.

 

[D]

Considering enrollment from the program standpoint, most programs serve some children across all these ages (as well as pregnant women) and so must provide services appropriate for each age group, including the prenatal period. A few programs serve only or mostly babies under 1 year old (not shown). Almost all programs serve at least some 1- and 2-year-olds, and most serve children primarily of these ages. While most Early Head Start programs serve younger infants and toddlers, a substantial number (about a third of all programs) do not serve 3-year-olds, consistent with the policy that Early Head Start is a 0 to 3 program, with 3-year-olds and older children being served by other programs such as Head Start. Differentials in the concentration of ages across programs may indicate that programs are efficient at transitioning children to other services as they reach age 3.

Table III.3. Characteristics of Early Head Start Children

		Percentage of Enrolled Children/Enrollment Slots
Age of Enrolled Children	Under 1 Year Old	22.2
	1-Year-Olds	31.4
	2-Year-Olds	36.8
	3-Year-Olds	9.5
	4-Year-Olds	0.1
Sample Size (Children)		46,317
Pregnant Women		8.2
Age at Program Entry	Prenatal	12.7
	0 to 2 years old	61.5
	2 to 3 years old	18.6
Age at Program Exit	Prenatal	2.1
	0 to 2 years old	16.2
	2 to 3 years old	23.3
	3 or more	46.0
Sample Size (All Enrollment Slots)		55,570

Source: Survey of Early Head Start Programs.

Although programs are not required to serve pregnant women, they are encouraged to do so, and if they do, they must comply with the performance standards in providing services. Most programs (84 percent) serve pregnant women, although relatively few may be enrolled at any one time and some programs that serve pregnant women may not have any enrolled at a given point in time. Among programs serving pregnant women at the time of the survey, the distribution ranges from just 1 woman (in 9 percent of programs) to 123 (less than 1 percent of programs). These women make up about 10 percent of enrollment in programs serving them. Looking at all Early Head Start enrollment slots, pregnant women fill 8 percent. Programs that serve pregnant women provide basic services as required by the performance standards, but they rarely provide specialized services. For example, of programs serving pregnant women, nearly all provide referrals (98 percent) and prenatal home visits (95 percent); most provide case management services (86 percent) and classes (60 percent). Programs rarely provide other types of services such as transportation, community activities, or doulas—childbirth coaches (all less than 10 percent). Box III.4 describes the unique challenges of serving this group of mothers-to-be and strategies to address them.

BOX III.4 RECRUITING, ENROLLING, AND SERVING PREGNANT WOMEN In addition to serving families with children aged birth to 3, Early Head Start strives to improve birth outcomes by targeting pregnant women for enrollment. Although programs are not required to serve pregnant women, they are encouraged to do so. The Head Start Program Performance Standards require that programs provide the following services to pregnant women if they do serve them: referrals for comprehensive prenatal and postpartum care, prenatal education on fetal development, and information on the benefits of breastfeeding. Here, we provide findings from both the survey and site visits about enrolling and serving pregnant women and the challenges of serving this population. Although most programs enroll pregnant women, some programs we visited rarely made special efforts to recruit them. In others, normal recruiting and referral sources (such as doctors’ offices, hospitals, Part C providers, and other community providers) are in place to fill slots for pregnant women. One program actively recruits first-time mothers who are immigrants or teenagers, or are in high-risk situations (such as homelessness). Pregnant women from these groups are recruited through high schools, maternity homes, the health department, and peer support programs. Transitioning to Early Head Start services after childbirth is often easier when families are enrolled in the home-based option. Transitioning from prenatal home visits to center-based services can be more challenging. Home-based programs indicated that transitioning after birth was usually a smooth process, in part because the visiting routine is already established and home visitors simply maintain the mother and child on an existing caseload. Center-based services present more difficulties. Enrolling an infant requires an open slot, adherence to standards about child-staff ratios, and, in some cases, state regulations or child care licensing requirements, all of which can present difficulties in placing an infant. For example, in one site, state child care licensing regulations stipulate a limited range of ages that can be served in a single classroom. As a result, at times infants must wait in home-based services for a center-based opening because staff cannot create a slot for them. Sometimes staff want to create an opening by advancing a child who seemed ready to move on to the next classroom. However, they cannot do so until he or she is old enough, so as not to violate the age range rule in the next classroom. In several other programs, overall low availability of infant slots makes transitions difficult. Transportation is a barrier in one program that cannot transport infants or toddlers without a parent in the vehicle. This rule makes it very difficult for working parents to enroll their children, even though they are the ones most in need of a center-based slot. Staff at programs we visited described three main challenges in serving pregnant women: (1) women’s belief that they did not need services until after the birth of the baby (desiring only a center-based slot); (2) making information seem relevant to experienced mothers who already had other children; and (3) overcoming resistance to receiving services, which is often related to cultural issues. Program staff attempt to address these issues by helping women understand the connection between prenatal care and later child outcomes, providing them with specific information on child development. Staff in some sites reported that teenage mothers are especially resistant to receiving services, in part because of their own developmental stage. Staff try to help mothers bond with babies before the birth and work to break down cultural barriers. Cultural issues cited by programs include language (occasional difficulty hiring bilingual staff), norms about visitors in the home, preferences to bottle-feed rather than breastfeed, and practices that make home visits difficult, such as the Vietnamese custom of secluding the mother and child in the home for two months after birth. Some programs struggle to employ staff who speak families’ languages and are familiar with their cultural backgrounds and norms (for example, hiring native Spanish-speaking staff rather than those who learned Spanish in school only).

Program Capacity. Most programs (62 percent) report that the number of children they serve matches their funded enrollment, while 20 percent of programs have more children enrolled than funded slots, and 18 percent have fewer children enrolled than funded slots (Table III.4). The Head Start Program Performance Standards allow programs 30 days to fill a vacancy, so there may be periods when enrollment is lower than the funded level if a few or many children leave at the same time.3 Temporary underenrollment may be particularly likely in the fall, when many children transition to Head Start. Box III.5 describes some strategies programs use to recruit families to Early Head Start.

 

Table III.4. Early Head Start Program Enrollment

Characteristics			Percentage of Programs
Enrolled at Funded Enrollment Level	At funded level		61.7
	Above funded level		19.8
	Below funded level		18.5
Program Maintains a Waiting List			100.0
	Program updated waiting list in past 6 months		95.6
	Number of children and pregnant women on waiting list	0 to 10	17.3
		11 to 50	37.7
		51 to 100	21.3
		100 or more	23.7
Sample Size (Programs)			583-648

Source: Survey of Early Head Start Programs

All programs maintain a waiting list for enrollment, and almost all update it regularly. Waiting lists, which include families with children or pregnant women already deemed eligible for Early Head Start services, are an important strategy to ensure that programs can quickly fill vacant slots when they become available. Just over half the programs report having waiting lists of 50 children or fewer, and three-quarters of programs have waiting lists of fewer than 100 children. However, roughly 15 percent of programs had very small waiting lists, of 10 children or fewer. Ninety-five percent of programs report that they had updated the list during the six-month period before the survey. Waiting lists indicate excess demand for Early Head Start and imply that with additional funding, many programs would be able to serve a larger number of families than they do currently.

 

BOX III.5 EARLY HEAD START FAMILY RECRUITING PRACTICES During site visit interviews, we explored the practices programs use to recruit families and how they ensure they are reaching those most in need. During our site visits, staff described how the recruitment process works in their programs, and we report that information here. Almost all the programs we visited report that it is easy for them to fill vacant enrollment slots when they become available, and about half do not recruit aggressively, because they consistently have long waiting lists. The most common ways families learn about the opportunity to enroll in Early Head Start are word of mouth from other enrolled families and referrals from other agencies. Programs reported that positive word of mouth is their most important recruitment tool. A few programs also reported that broader visibility and engagement in the community are important to them, and they achieve these through efforts such as participating in coordinating councils and attending or speaking at community events. In addition, Early Head Start programs accept referrals from other community agencies, such as early intervention programs or disabilities service agencies, public schools, child care providers, health departments and providers, shelters and public housing, social services and child welfare agencies, WIC, mental health agencies, and Head Start programs. Some programs also reported recruiting families by contacting these community agencies when slots were expected to open up (such as in the fall when many Early Head Start children transfer into Head Start or other preschool programs). Many programs we visited place brochures, flyers, or other information about the program in various community locations to attract new applicants, and one program reported attending enrollment days at the local public school to inform families about Early Head Start. A few programs placed ads or announcements in local media or agency bulletins, and a few also report going door to door in target neighborhoods to recruit families. About half the programs we visited report targeting specific groups for enrollment and making special efforts to recruit and enroll these families. Commonly, programs make special efforts to recruit children with disabilities, as programs are required to make available 10 percent of their slots for children with special needs. A few of the visited programs targeted teen parents, and a couple also targeted homeless families. A few programs we visited set aside a specific number of enrollment slots for pregnant mothers but do not recruit actively to fill these slots. Programs typically identify pregnant mothers from among the families already enrolled in Early Head Start, either through word of mouth or through referrals from WIC or other agencies. None of the visited programs indicated that they target particular racial, ethnic, or cultural groups for enrollment. The low threshold for income eligibility, as well as requirements for parental employment and program participation, made it difficult for some families to enroll in Early Head Start. Most programs had little difficulty maintaining full enrollment; moreover, more than half the programs we visited complained that they cannot serve all who are in need. One program noted that income eligibility rules are a particular challenge for enrolling teen parents. If a teen is still a dependent, her eligibility assessment must include the income of her own parents; therefore, many do not qualify for Early Head Start. Site visit interviews highlighted other barriers to enrollment for some potentially eligible families. For example, program options that require a lot of family participation created barriers for some families, particularly for those with limited flexibility because of full-time work or school, lack of transportation, language differences, and hesitation or fear about participating (particularly for undocumented families). One program noted that the waiting list itself is a barrier for families that need care right away. Programs we visited try to adapt their services and approaches to reduce the barriers to enrollment where possible. For example, one program with stringent eligibility requirements from a state grant is seeking a waiver for Early Head Start families to exempt them from some of the requirements. Another program decided to increase the number of center-based slots it offers because a lot of families have trouble fitting home visits into their schedules. Programs also make adaptations to address cultural or language barriers, such as hiring bilingual staff, bringing in translators, and finding alternative ways to verify income for families without documentation.

EARLY HEAD START FAMILY CHARACTERISTICS

Early Head Start programs serve families from a wide variety of racial and cultural backgrounds. The performance standards do not explicitly require programs to serve families of different races or cultures in their communities. However, the standards do require that programs individualize services to the needs and circumstances of families who live in their service areas and to serve families that are representative of eligible families in the community.

The families that most Early Head Start programs serve vary widely in race/ethnicity and speak many different languages, and this affects program management and staffing. Cultural competence among staff and service delivery approaches that support and honor the home cultures and languages are required by the Head Start Program Performance Standards and are reflected in the performance measures. In programs that serve families from a diverse mix of cultural backgrounds, directors/managers strive to hire staff with cultural backgrounds similar to those of enrolled families and to provide services in a culturally appropriate manner. In this section, we present population-level and program-level survey data on family characteristics separately, then compare the differences between these units of analysis. Box III.6 describes the ways that programs work to ensure they respect the cultures of families they serve.

Population-Level Demographics

Race/Ethnicity. The families served by Early Head Start are diverse in terms of race and ethnicity. The most common racial/ethnic groups among Early Head Start children are white/Caucasian, black/African American, and Hispanic/Latino (Figure III.2). Whites make up the largest proportion of enrolled families (33 percent). African Americans and Hispanics (of any race) make up roughly equal proportions of total enrollment (26 and 25 percent, respectively). Among others, served in much smaller proportions, are American Indian/Alaska Native; Asian, Hawaiian, or Pacific Islander; and biracial or multiracial. We find roughly similar information in the 2004–2005 PIR: 34 percent white, 27 percent black, and 29 percent Hispanic (not shown).

Language. About one-quarter of families served by Early Head Start primarily speak a language other than English. This figure is higher than analogous information in the PIR, where 20 percent of families speak such a language (not shown). Among those speaking a language other than English, Spanish is by far the most common, both in this survey (81 percent; Figure III.3) and in the PIR. There is such variety among the languages spoken by Early Head Start families that no one language apart from Spanish dominates. Three percent of families speak an Asian language, and a similar number speak a European language. The remaining 13 percent speak a variety of other languages, such as Arabic, Vietnamese, Swahili, or native Central and South American languages.

BOX III.6 RESPECTING FAMILY CULTURE IN EARLY HEAD START PROGRAMS Cultural competence is an important part of the performance measures framework for Early Head Start; programs are expected to understand the cultural differences among families and design their programs to support families’ home cultures. The following information from our site visit interviews describes how programs respect home cultures and ensure cultural competence in service delivery. Early Head Start programs we visited emphasize respecting family cultures and traditions, even in less diverse programs. Respecting family culture often means understanding and being sensitive to practices and beliefs from other racial or ethnic groups. Language and communication are the most obvious challenges for programs serving families from diverse cultures, and programs use many strategies to address these and other cultural challenges. Programs use strategies to ensure culturally competent services, such as hiring staff who are representative of the service population (or at least speak the same languages) and offering diversity or language training to staff. Most programs try to hire culturally representative or bilingual staff, although some said it is not always possible to find enough staff with these qualifications. About half the programs we visited reported offering diversity or language training to staff, as well as encouraging staff to do research or ask parents about their cultural values, traditions, and practices. Programs address language differences in a variety of ways. Some use translators, provide parents with materials in their primary language, or integrate cultural traditions and languages (such as songs or books) into the curriculum and classroom environment. A few programs offer acculturation support services for parents, such as English or literacy courses. Some programs adapt program services (for example, by providing vegetarian meals, not celebrating Christian holidays, celebrating holidays from many cultures, or holding multicultural events). Programs that encountered differences in cultural childrearing practices are mostly accepting of different practices or take tactful approaches to suggest changing them. Differences in childrearing are related primarily to disciplinary practices (such as spanking) and dietary or nutrition practices (such as mixing rice with infant formula, bottle-feeding to an advanced age, or allowing young children to drink coffee). Program staff generally indicated that they respect cultural or family childrearing practices unless they present a danger to the child or are against the law. However, some programs attempt to influence family practices by using strategies such as sharing positive behavior management techniques and having a nutritionist or nurse explain the health effects of poor nutrition. Additional challenges for programs related to serving a culturally diverse population include serving families with undocumented immigration status and contending with cultural stigmas against obtaining certain social and health services. Undocumented families presented a significant challenge to several programs. Although immigration status does not bar participation in Early Head Start, it does present challenges in obtaining resources such as employment, housing, bank accounts, health care, and transportation for families. Other problems related to immigration status include a lack of income documentation to determine Early Head Start eligibility and overcoming families’ fears and suspicions of being reported to immigration enforcement. Among some cultural groups, programs are also challenged to overcome social stigmas against seeking services related to mental health, disabilities, and domestic violence. Furthermore, families from some cultures are not accustomed to seeking preventive and oral health care, so programs have to work hard to inform families about the importance of these services for the well-being of their family.

 

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Program-Level Demographics

Race/Ethnicity. Although a small minority of programs serve one race/ethnicity exclusively, most serve a population that is at least somewhat diverse. Diversity within programs affects program staffing and services, as programs serving multiple races and ethnicities need to provide culturally competent services for all groups. More than 60 percent of Early Head Start programs report serving children or pregnant women from at least four racial/ethnic groups, and almost 20 percent of programs serve as many as six (Table III.5). Few programs serve children and pregnant women of just one specified race/ethnicity: 3 percent of all programs serve only American Indian/Alaska Native, 3 percent only Hispanic (any race), 2 percent only black/African American, and 1 percent only white children and pregnant women. Not unexpectedly, 12 of the 16 programs serving only American Indian or Alaska Native children and pregnant women operate under the American Indian/Alaska Native program branch, which tailors services and program structure to the needs of these cultural groups. Similarly, 7 of the 16 programs serving only Hispanic children and pregnant women are located in Puerto Rico.

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Few programs serve multiple races without one being dominant. About a quarter of Early Head Start programs are dominated by one race/ethnicity (90 percent or more of their service populations) but also serve others: close to half of programs serve a population that is 75 percent or more of one race or ethnicity. The dominant race/ethnicity in these programs is most frequently white or African American, followed by Hispanic or Latino.4 Two-thirds of the Early Head Start programs operated by the American Indian/Alaska Native branch served 90 percent or more children of this racial category, and many of the other children served are identified as biracial or multiracial.

Among programs serving Hispanic or Latino families, 21 percent report that the number of such families enrolled has increased during the past five years. Changing demographics are important to program management, because as service populations shift, programs must adapt to ensure that they continue to provide culturally sensitive services (not shown). Among programs serving other than Hispanic racial and ethnic groups, most report that the racial/ethnic composition of their population is unchanged in the past five years.

Table III.5. Demographics of Early Head Start Families: Program Level

Characteristics		Percentage of Programs
Programs Serving Multiple Races/Ethnicities	4 or more races or ethnicities	62.9
	6 or more races or ethnicities	18.9
Programs Serving Primarily One Race/Ethnicity	90 percent or more families of same race/ethnicity	27.2
	75 percent or more families of same race/ethnicity	47.9
Families Enrolled in Programa	White/Caucasian (non-Hispanic)	81.7
	Black/African American (non-Hispanic)	76.0
	Hispanic/Latino, any race	75.1
	Biracial/multiracial	70.1
	Asian/Hawaiian/Pacific Islander	29.7
	American Indian/Alaska Native	26.6
	Other race/ethnicity	19.3
Programs Serving Multiple Languages	2 or more languages	33.6
	4 or more languages	8.2
	6 or more languages	2.0
Sample Size (Programs)		646-648

Source: Survey of Early Head Start Programs. a Race/ethnicity is provided by programs according to the group the family chooses. All race and ethnicity categories are mutually exclusive. Hispanic or Latino families of any race are included in one category, and other race categories exclude families that are Hispanic or Latino.

Language. Most programs serve Spanish-speaking families, although a substantial minority also serve families that speak other languages. Programs serving families that do not speak English must find ways to communicate, usually by hiring bilingual staff, using translators, and translating program materials. Although the Head Start Program Performance Standards do not include specific easily measurable requirements to display cultural competence, they do emphasize that services should be designed to accept and support families’ home language and cultural practices, and, where possible, staff should speak the home child’s language. It is difficult for some programs to find qualified bilingual staff to meet the needs of these families, especially non-Spanish speakers, and they may not be able to do so if only one or two families speak a particular language. In general, communication is more complicated for programs serving families that speak several different languages rather than just one non-English language.

Almost two-thirds of programs serve at least some Spanish-speaking families, and 40 percent serve families that speak other languages. Other languages spoken by families in at least 10 percent of programs include Middle Eastern languages, such as Arabic or Hindi; East Asian languages, such as Vietnamese or Japanese; African languages, such as Swahili or Wolof; and native Central and South American languages, such as Quechua or Aymara (Figure III.4). Programs often work with more than one language among non-English speakers: 34 percent of programs have two or more languages spoken by different families, and 8 percent have four or more.

Comparison of Program-Level and Population-Level Demographics

Language and cultural issues are important for Early Head Start at the national level, not just in particular areas of the country. Most programs serve heterogeneous racial/ethnic groups in addition to those speaking diverse languages. White, African American, and Hispanic children each make up about a third of the entire Early Head Start population but are distributed fairly evenly across more than three-quarters of programs. Although biracial children make up just 6 percent of the total population, they are served by almost three-quarters of programs (Table III.5). Similar patterns are true of American Indian or Alaska Native children and Asian, Hawaiian, or Pacific Islander children as well, but these groups make up small percentages of the total population, and both are served by about a quarter of programs.

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A sizable minority (23 percent—not shown) of Early Head Start families primarily speak a language other than English, but most Early Head Start programs (72 percent) serve at least one family that speaks another language. Some programs serve more non-English-speaking families than others, but most must contend with language and associated cultural communication issues with at least some families. Early Head Start’s administrative data source, the PIR, supports this finding. According to the PIR, 63 percent of programs serve at least some non-English-speaking families.

Family Risk Factors

Besides providing education services for enrolled children, programs must assess each family’s needs and provide or connect families with services to meet them. Because programs prioritize the families with greatest need for enrollment, families served by Early Head Start often have many critical issues for which programs must provide or arrange services. Box III.7 shows examples of needs gleaned from site visits.

All Early Head Start families are “at risk,” because Early Head Start serves families with incomes at or near the poverty threshold. Programs often identify additional risk factors, either demographic or psychological. Demographic risk factors typically include single parenthood, teen parenthood, receipt of public assistance, unemployment, or low educational attainment. Psychological risk factors include mental health and substance abuse problems. Other risk factors include living in an unsafe neighborhood and experiencing family violence. As part of the Early Head Start Research and Evaluation Project (EHSREP) impact study, researchers found a high rate of both demographic and psychological risks. Furthermore, the patterns of service use and impacts for children and families varied by level of risk. In terms of demographic risk, the five demographic factors listed above were used to form a cumulative risk index by looking at families with low, medium, and high total number of risks. Families at medium and low risk had the greatest positive program impacts, and although families at high risk did not benefit from Early Head Start at age 3 (ACYF 2002), they did experience positive impacts when children were about age 5 (ACF 2006).

In terms of psychological risks, the EHSREP looked only at maternal depression as a moderating factor. At age 3, at the completion of the program, there was a pattern of positive impacts, particularly on parenting, for families where primary caregivers were depressed at enrollment into the program. The impact study also found that the program had new positive impacts on maternal depression when children were in their prekindergarten year (ACF 2006). Importantly, the program was able to engage families with both demographic and psychological risk factors, although they did leave the program at a higher rate then lower-risk families. As we know, the prevalence of any of these risk factors in the families served by each program influences the services provided, the types of staff hired, and the kinds of partnerships formed and is therefore important to understanding how programs individualize services.

BOX III.7 ADDRESSING FAMILIES’ SOCIAL SERVICES NEEDS IN EARLY HEAD START PROGRAMS Early Head Start programs individualize services for the families they serve, so identifying and addressing families’ social services needs is an important part of working with families. Understanding family needs also helps programs identify high-risk families and connect them to resources and supports. Programs reported identifying family needs through intake applications, family partnership agreements, ongoing information from home visits or conversations with program staff, staff observations, and general parent needs surveys. Below, we use data from our site visits to identify common family social services needs reported by programs and to describe the challenges programs faced and the strategies they use to address family needs. According to staff in the Early Head Start programs selected for site visits, the most important family needs include housing, employment, and transportation. Other key needs include health and dental care, child care, mental health services, adult education and training, and parenting skills training. Program staff tended to identify housing, employment, and transportation as the most pressing concerns for families, although other needs such as health and dental care were identified by nearly all programs. Family problems related to housing are also common, including housing quality and affordability, overcrowding, transience, and periodic or long-term homelessness. Employment issues included unemployment, underemployment, and insufficient wages. Transportation is a particular problem in rural counties but was also a concern for a few urban programs; this is an especially important need to address, because it creates barriers to employment and limits participation in most services, including Early Head Start. Many programs reported that mental health services are a need for their families, as well as basic education, literacy, and job training. Several programs, particularly those implementing the home-based option, reported that quality child care is a need. Programs reported that families need support with parenting skills and family violence. Other needs that a few programs mentioned include substance abuse services, supports for young or teen parents, nutrition and food assistance, and financial difficulties such as debt and poverty. Overcoming families’ mistrust was the challenge programs most often mentioned related to meeting family needs. In some cases, the difficulty establishing trust stems from parent suspicions or resistant attitudes; in others, it appears to be related to cultural taboos about acknowledging family problems such as mental health issues or developmental delays. Several programs reported significant difficulties in obtaining services for undocumented families, including eligibility criteria for the services and trust issues for the families. Other challenges included limited availability of services in the community, time constraints for employed parents, and language barriers. About half the managers in programs we visited mentioned stressful working conditions as a barrier to meeting families’ needs. Despite programs’ efforts to support staff, staff are continually challenged by personal boundary issues, the stress of crisis management, and the lack of immediately evident improvements in family circumstances. Programs use a variety of strategies to address the challenges they face in meeting family needs, tailored to specific local needs and challenges. In general, program strategies for addressing these challenges included supporting staff in the work they do, informing families about available service options and their benefits, working to link families to needed services, providing services directly at the program, and using program funds to pay for needed services when necessary. Programs often used combinations of these strategies. For example, one program reported problems in connecting families to services because services are limited in the community and service locations are spread out. To address these challenges, the program provides certain services itself and uses program funds to help pay for others. The program also developed a buddy system for families to make appointments together to share transportation. Another program reported that cultural differences make it difficult for some families to recognize needs such as preventive health care and mental health, because those services were not available in many families’ home countries. The program offers information to families about the American service delivery system and the cultural expectations related to childrearing. The program respects family cultures but informs families about and encourages them to take advantage of services, for the benefit of both the child and the family.

For ease of discussion, we created four mutually exclusive categories that describe the concentration of families with each type (demographic or psychological) of risk factors in a program: low, moderate, high, and very high. A low concentration means that a program serves 10 percent or fewer families with that risk factor, a moderate concentration is between 11 and 50 percent, a high concentration is between 51 and 75 percent, and a very high concentration is 76 percent or higher. The survey data in this section are reported at the program level (figures III.5 and III.6). Box III.8 describes program staff members’ views of high-risk families from our site visits.

Demographic Risk. Among demographic risk factors described earlier, including single parenthood, teen parent, welfare receipt, unemployment, and low educational attainment, single parenthood is the most prevalent. More than half of Early Head Start programs report high or very high proportions of single-parent families in their enrollment; less than 2 percent of programs report low proportions of families with this risk factor (Figure III.5; Table III.6). Low educational attainment occurs at more moderate levels: more than two-thirds of programs serve a moderate proportion of families in which the primary caregiver does not have a high school diploma or a GED. About one-quarter of programs serve moderate to high proportions of families receiving welfare payments. Unemployment is somewhat lower, with more than 80 percent of programs serving low or moderate proportions of unemployed families. Teen mothers make up a low proportion of enrollment in most programs. As some programs specialize in serving this population, concentration within a few programs makes sense. Most programs serve families that have three or more demographic risk factors, and about 20 percent of programs serve a high concentration of such families. Although not all programs serve families with multiple risk factors, all programs serve families that have some risk factors. The co-occurrence of demographic risk factors is to be expected, because individual risk factors can increase the chance of experiencing one of the others (for example, teen parents are more likely to be single, lack a high school credential, and or be unemployed [Maynard 1997]).

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BOX III.8 HIGH-RISK FAMILIES IN EARLY HEAD START Site visit data portray a more complex picture of high-risk families than the survey suggests, with about half the programs we visited indicating that they serve only or primarily high-risk families. Our site visit interviews with program staff suggested that programs generally define high-risk families as those in acute crisis. One program director explained that families move in and out of crisis on a regular basis and experience different risk factors at different times. For example, a family can suddenly become homeless, initiating a crisis period involving several other risk factors such as substance use or depression. Later, the family’s risk might be reduced as Early Head Start provides services to resolve these issues. Another director characterized most of the families served as “on the brink” of serious crisis. The challenges and strategies related to working with high-risk families were similar to those described in this chapter for addressing family needs, but staff reported providing them in a more intensive manner for families in crisis.

Table III.6. Prevalence of Demographic and Psychological Risk Factors Across Programs

		Percentage of Programs
		Less than 11 Percent of Enrollment	11 to 25 Percent of Enrollment	26 to 50 Percent of Enrollment	51 to 75 Percent of Enrollment	More than 75 Percent of Enrollment
Demographic Risk Factors	Teen mother	51.5	31.3	11.4	1.8	4.0
	Single parent	1.7	9.4	34.9	32.7	21.4
	No high school diploma/GED	13.5	33.1	35.8	13.6	4.1
	Receive welfare	24.5	23.4	24.1	13.4	14.6
	Unemployed/not in school	27.5	26.6	29.7	12.4	3.8
	More than 3 demographic risks	19.2	27.9	31.2	14.1	7.6
Psychological Risk Factor	Mental health problems	46.7	28.5	17.9	5.8	1.1
	Substance abuse problems	54.3	30.6	11.8	2.8	0.4
	Reside in unsafe neighborhood	37.3	20.6	18.1	10.8	13.3
	Experience family violence	39.1	34.5	5.7	5.7	1.7
	More than 2 psychological risks	36.6	31.0	19.8	9.6	3.4
Sample Size (Programs)		634-648

Source: Survey of Early Head Start Programs.

Psychological Risk. Psychological risk factors such as those we describe here present difficulties for staff working with families, even if they occur at low frequency. Living in an unsafe neighborhood is the most prevalent psychological risk factor; about one-quarter of programs have high or very high proportions of families living in these conditions (Figure III.6; Table III.6). Programs tend to serve moderate proportions of families experiencing family violence. About half of programs serve relatively low proportions of families with substance abuse or mental health issues; for each of these risk factors, around 5 percent of programs serve high or very high proportions. Relatively low concentrations of mental health concerns are somewhat surprising, given what we learned in the site visits (Box III.8) and in the EHSREP, where 50 percent of families had depression at baseline, and about one-third had depression when children were 14 and 24 months of age. Mental health issues may prevent them from taking the initiative to apply for the program in the first place or can make ongoing participation difficult, or staff may not recognize mental health problems among parents. When considering the co-occurrence of risk factors, about 15 percent of programs serve high or very high concentrations of families with two or more psychological risk factors.

Children with Disabilities

Federal performance standards require that programs make 10 percent of their enrollment slots available to children with special needs. Therefore, the Early Head Start program is an important source of services for young children with disabilities or developmental delays. Indeed, in some communities, Early Head Start is the only infant and toddler program that will accept children with disabilities.5 Programs are not required to meet the 10 percent enrollment at all times, but they must make demonstrated and ongoing efforts to enroll children with special needs. Because disabilities can be difficult to identify in children under 3, especially infants, the screening and identification process often occurs over a period of time and precedes a formal evaluation by an early intervention provider (Chapter VI details this process).

Program Level. Three-quarters of Early Head Start programs report that at least 10 percent of their total enrollment has developmental concerns, and many programs serve much higher concentrations of children with special needs. Nearly one-fifth of programs have very high concentrations (30 percent or more) of children with developmental concerns, and 5 percent of programs report that at least half their caseloads have been referred for evaluation of a developmental concern. Five percent of programs reported that they did not serve any children with special needs at the time of the survey. A small proportion (2 percent) reported that all the children served have special needs. More typically, programs serve a caseload consisting of 10 to 30 percent of children with identified or suspected special needs. The percentages counted here include children who have been referred for evaluation of a developmental concern but may not yet have been evaluated (Figure III.7).

Prevalence of Developmental Concerns Within the Early Head Start Population. Identifying a disability may entail several stages, the first of which involves talking with the family to verify the observed issues and choose a course of action. It is relatively rare for staff to report having concerns about a child but not yet having referred that child for further evaluation (4 percent, not shown). After conferring with the family, the next step is referring the child for evaluation of the concern identified by program staff.6 Across the universe of Early Head Start children, a fifth have been referred for further evaluation, most commonly as a result of concerns about communication disorders and developmental delays. Before we describe the process of identification in Chapter VI, we here describe the prevalence of disabilities in the population of Early Head Start children. Of the Early Head Start children that have been referred for evaluation of a suspected disability, many are receiving services (76 percent; Table III.7).

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Among children who have been referred for evaluation, after accounting for communication (speech or language) disorders in 9 percent of children and developmental delays (such as autism or Down syndrome) in 6 percent, less common concerns include emotional or behavioral issues, physical or orthopedic impairments, sensory impairments (such as blindness or deafness), and others (all less than 2 percent). Box III.9 gives a fuller picture of developmental concerns among Early Head Start children from site visits.

BOX III.9 CHILDREN WITH DISABILITIES IN EARLY HEAD START PROGRAMS Serving children with disabilities is part of Early Head Start’s mission. Federal performance standards require that Early Head Start programs make 10 percent of their enrollment slots available to children with disabilities, and programs are required to make special efforts to meet this percentage by recruiting children with disabilities and identifying special needs among children already enrolled. The following data from our site visits describe how programs comply. Some programs have difficulty ensuring that 10 percent of enrolled children are those with special needs, while others have so many children with special needs that they must work hard to keep a mix of special-needs and typically developing children in classrooms. Children with disabilities in the programs we visited range from 3 to about 50 percent of enrollment, with most programs’ caseloads at 10 to 20 percent. These percentages change on an ongoing basis as children with special needs are identified. Some programs have difficulty with having too many or too few children with disabilities. One center-based program whose enrollment of children with disabilities is 50 percent reported it had to stop accepting children with disabilities, because it would no longer be an inclusion program. Early Head Start programs provide inclusive or integrated services to children with and without disabilities rather than have segregated services for children with special needs alone. For some programs, this requires particular effort not to have high percentages of children with disabilities in any one classroom. For example, one program is operated by a disabilities services agency, and about a quarter of the children it serves have special needs. The program reported that it targets children with special needs and does not have difficulty identifying and enrolling them, but staff have to work hard to ensure that Early Head Start classrooms have a mix of typically developing and special-needs children rather than too many children with special needs. Other programs have very small percentages of children with disabilities. Programs identify children with special needs through their own screenings and child assessments conducted regularly in Early Head Start, but they also enroll children with disabilities that have already been identified. Some programs make special efforts to target families with special-needs children for enrollment, but several programs we visited reported that they do not need to do much active recruiting for these families. Most programs accept referrals from Part C early intervention providers, and some received so many referrals that they could not accept them all.1 Some grantee agencies also have early intervention or other disability services providers co-located with the Early Head Start program and so do not need to recruit actively. One program is the only early childhood program in the community that serves infants and toddlers with disabilities, so it is able to enroll plenty of children with special needs without actively recruiting. Ongoing screenings and assessments in Early Head Start also uncover special needs among children already enrolled in the program without the need to recruit them specifically. Still, some programs we visited have very low enrollment of children with special needs. Some disabilities are difficult to identify in infants and toddlers because their early stage of development makes it hard to observe delays, and the age of onset of certain developmental milestones ranges widely. One program with a very low enrollment of children with special needs reported that it does not have the facilities or staff expertise to serve children with severe disabilities. 1 These are disability services providers for infants and toddlers with special needs, authorized under Part C of the Individuals with Disabilities Education Act. (back to note 1)

Table III.7. Prevalence of Developmental Concerns Among All Early Head Start Children

Characteristic		Percentage of Enrolled Children
Children Who Have Been Referred for Evaluation		20.3
Sample Size (Children)		41,333
Among Referred Children	Eligible for/receiving Part C services or has IFSP	75.6
Specific Concerns Among Children Eligible for Part C Services a	Communication disorder	42.2
	Developmental delay	32.4
	Emotional or behavioral issues	7.8
	Physical or orthopedic impairment	9.1
	Sensory impairment	3.0
	Health or mental condition	0.8
	Other developmental concern	4.6
Sample Size (Children)		6,335

Source: Survey of Early Head Start Programs. a These children have been referred for Part C evaluation, have been found eligible, and may be receiving Part C services.

KEY POINTS

• Early Head start programs are equally likely to be located in urban or rural areas. Many are in areas of increasing cultural diversity.

• Most Early Head Start programs are run by nonprofit community agencies.

• Most Early Head Start programs obtain outside funding in addition to the Early Head Start grant funds to supplement program services. Programs that do not report receiving outside funds may receive in-kind contributions, but we did not ask about those in the survey.

• About one-third of Early Head Start programs are small, serving 50 or fewer children and pregnant women; nearly three-quarters of programs serve 100 or fewer. A small number of programs are very large, with enrollment in the hundreds.

• Most Early Head Start children enter the program between birth and age 2 and do not leave until they have reached age 3. About 13 percent of children enter the program during the prenatal period.

• All programs surveyed maintain a waiting list for enrollment of eligible families and prioritize families by their level of need. Most programs are either at enrollment capacity or overenrolled.

• Whites, African Americans, and Hispanics make up the majority of the Early Head Start population, but many other racial/ethnic groups are represented in programs. More than 60 percent of programs serve 4 or more different racial/ethnic groups.

• About one-quarter of families served speak a language other than English; however, they are distributed across nearly three-quarters of programs. Thirty-four percent of programs serve families speaking two or more languages; 8 percent have 4 or more languages represented.

• Fairly high levels of family risk factors are prevalent across Early Head Start programs, in part because programs prioritize the families with greatest need for enrollment. Some programs serve many families with multiple risk factors, and these risk factors present programs with many service and management challenges. About 15 percent of programs report serving families with multiple psychological or demographic risks.

• Three-quarters of Early Head Start programs reported that at least 10 percent of the children they serve have developmental concerns; nearly one-fifth of programs serve concentrations of more than 30 percent children with special needs.

• Communication disorders and developmental delays are the most common types of developmental concerns among Early Head Start children.

• Across the total Early Head Start population, about 20 percent of children have been referred for evaluation, and in about 5 percent of programs, nearly half the children have been referred for evaluation. Among children referred for evaluation, most are receiving services (76 percent).

• Eighty-four percent of programs serve pregnant women, although not all responding programs had any pregnant women enrolled at the time of the survey.

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